Meta-analysis finds antibiotics alone comparable to drainage for pediatric post-appendectomy abscess

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Pediatric surgery international Published May 15, 2026 Medically reviewed May 15, 2026 Study authors: Grochowska Agata, Hinduja Kirti Kumar, Marques Alana Larissa Aparecida, Mena Laura Helena Fuenmayor,… PubMed ↗ DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Consider antibiotics alone as a first-line option for stable pediatric patients with post-appendectomy abscess, given comparable success and shorter hospital stay.

This systematic review and meta-analysis evaluated the effectiveness of antibiotics alone (conservative management) versus invasive drainage for post-appendectomy intra-abdominal abscess in pediatric patients aged 0-18 years. The analysis included 363 patients (152 drainage, 211 conservative) from observational studies.

For treatment success, there was no statistically significant difference between groups (RR 1.00, 95% CI 0.95-1.05), with success rates of 80.9% for drainage and 89.1% for conservative management. Recurrence also showed no significant difference (RR 0.99, 95% CI 0.57-1.74). However, length of hospital stay was significantly shorter with conservative management (mean difference 3.40 days, 95% CI 0.65-6.14, p=0.02).

The authors note a critical limitation: all included studies demonstrated a serious risk of bias due to confounding by indication. This means patients selected for conservative management may have been less severely ill, potentially biasing results in favor of antibiotics. The evidence is therefore low certainty.

For clinical practice, an antibiotics-first approach appears viable for clinically stable pediatric patients with post-appendectomy abscess, achieving comparable outcomes with shorter hospitalization. However, these findings should not be generalized to unstable patients or those with large abscesses, and superiority of antibiotics over drainage cannot be claimed based on this meta-analysis.

Study Details

Study typeMeta analysis

EvidenceLevel 1

Follow-up216.0 mo

PublishedMay 2026

PMID42113215

View Original Abstract ↓

Post-appendectomy intra-abdominal abscess remains a common complication following pediatric appendicitis. Although drainage has traditionally been considered standard treatment, increasing evidence suggests selected patients may be successfully managed with antibiotics alone. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251075191). PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched through June 20, 2025. Eligible studies included pediatric patients (0-18 years) with post-appendectomy abscess managed with antibiotic vs. invasive drainage. The primary outcome was failure of first-line treatment requiring escalation. Secondary outcomes included recurrence and length of hospital stay. Ten observational studies involving 363 pediatric patients were included (152 drainage, 211 conservative). Treatment success was 80.9% with drainage and 89.1% with antibiotics. Pooled analysis demonstrated no statistically significant difference in treatment success (RR 1.00; 95% CI 0.95-1.05) or recurrence (RR 0.99; 95% CI 0.57-1.74). Drainage was associated with longer hospital stays (MD 3.40 days; 95% CI 0.65-6.14; p = 0.02). Subgroup analyses demonstrated consistent findings. All included studies demonstrated a serious risk of bias due to confounding by indication. An antibiotics-first approach appears viable for clinically stable pediatric patients, achieving comparable outcomes with shorter hospitalization.